Running head: HEALTH CARE DISPARITIES 1

Health Care Disparities: American Indian/Alaska Native

Amy Johns
Ferris State University

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Abstract
This paper is a brief summary of health and health care disparities in a minority population of the
United States. Concepts are analyzed in the context of a Community Nursing class required for a
Bachelor of Science in Nursing Degree. It focuses on obesity and diabetes rates in the American
Indian/Alaska Native population with a discussion of contributing social determinants and
relevant health care policy.

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Health Care Disparities: American Indian/Alaska Native
Disparities exist among the health and well-being of the citizens of the United States
related to race/gender/ethnicity. Disparate populations are affected by poverty, lack of education,
mental health disorders and traumatic social histories, and other social determinants. This paper
will define American Indian/Alaska Native (AI/AN) and briefly discuss the disparities that
exist in the rates of obesity and diabetes in the American Indian/Alaska Native population. It
will also discuss the social determinants and healthcare policies that may be relevant.
Population: Definition and Demographics
The Office of Minority Health, a branch of the US Department of Health and Human
Services (USDHHS), defines the American Indian/Alaska Native (AI/AN) population as a
racial group [that] includes people having origins in any of the original peoples of North
[America], South America, and Central America, who maintain tribal affiliation or community
attachment (para. 1). In 2011, this group consisted of 6.2 million people, or 2% of the US
population, and includes members who are also combinations of other races. There are 566
federally recognized and 100 state-recognized tribes. Most of this population lives in rural areas
or on tribal reservation lands in the Western and Southwestern US and is served by a subsidiary
of the USDHHS called the Indian Health Service (IHS). AI/ANs who live in urban areas are
typically not reached by the IHS and are medically underserved, resulting in poorer health
overall. (Office of Minority Health, 2012a)
Health Disparities: Obesity and Diabetes
Felicia Mitchell (2012) writes in her article Reframing Diabetes in American Indian
Communities: A Social Determinants of Health Perspective, As a collective, AI/ANs
experience some of the greatest health inequities of any group within the United States (p. 71).
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Rates of many health indicators that are indicative of a high-risk or underserved population are
very high in the AI/AN population, but obesity and diabetes will be focused on for this purposes
of this paper.
Obesity is an epidemic in the United States among many populations but it is higher in
AI/ANs. In 2010, 39.6% of the adult population of AI/ANs was obese, a rate 1.6 times higher
than that of non-Hispanic whites (Office of Minority Health, 2012b).
Nationwide in 2012, 16.3% of the adult population of AI/AN had diagnosed diabetes, a
rate 2.1 times higher than for whites. This varies from region to region with a high of 33.5% in
the AI population in southern Arizona (Mitchell, 2012, p. 71). In 2009, an AI/AN was 1.8 times
as likely to die from diabetes as a white person (Office of Minority Health, 2012c).
Relevant Social Determinants: Social History, Poverty, Education
As stated earlier, many AI/ANs live in rural areas or tribal reservation areas that are
medically served by the IHS. Those who live in urban areas are medically underserved and have
poorer health outcomes.
The social history of AI/ANs (specifically AIs) is closely linked to that of the
colonization of the North American continent by European settlers. Immigration of these
colonials brought disease to the indigenous people which ravaged their numbers. Then, with the
movement of the colonials westward, AI people were forced to relocate by a Congressional order
passed in 1820 called the Indian Removal Act. The Federal Government Boarding School
Movement began in 1875 and AIs were removed from their native culture and educated in
American ways, Christianity and civilized ways (USDHHS, 2001, p. 79). These actions,
and others like it, created within the race of American Indians, a historical, intergenerational
trauma and, unresolved grief caused by loss of traditional lands and cultural identity,
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genocide (Mitchell, 2012, p. 72). This troubled history has many mental health consequences
and implications that manifest in poorer health and lower quality of life.
In 2010, AI/ANs were reported to live at or below poverty level at the disproportionately
high rate of 28% as compared to 10.6% for non-Hispanic whites (Office of Minority Health,
2012e). Lower socioeconomic level is correlated with poorer health outcomes and quality of life
(HealthyPeople.gov, 2012).
High school graduation rates for AI/ANs are lower than that of whites, with 77% of
AI/ANs over the age of 25 having a high school diploma versus 91% of whites (Office of
Minority Health, 2012d). Lower educational level is correlated with lower health status.
(Koivusilta, Rimpela, & Vikat, 2003).
Policies Affecting AI/AN Health Disparities
Our national policies regarding mental health care have, perhaps, the largest single effect
on the AI/AN population. The social history of AIs has predisposed them to poverty, lower
education rates, poorer health outcomes and race-wide depression and anxiety. Negative mental
health consequences have resulted from the forced separation of children from their families to
attend boarding schools (USDHHS, 2001, p. 83). These negative mental health consequences
improve with treatment (USDHHS, 2001, p. 84).
As stated earlier, the federally-run Indian Health Service is responsible for providing
health care to the 500+ tribes of AI/ANs in the US but only 1 in 5 members of this group report
accessibility to these IHS resources. Also, there is huge scarcity of AI psychiatric health care
providers (USDHHS, 2001, p. 91). Better policy with regard to mental health care of the AI
population would have an impact on these health care disparities.

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Contributing Factors
In my opinion, this is a multi-factorial problem. I think that one contributor is the fact
that AI/ANs make up only 2% of the population. This makes it more difficult to allocate
adequate resources from that which is available to public health causes. Another factor may be
the amnesia or ignorance of the medical/congressional/professional policy makers with regard to
the legitimacy, pervasiveness, intensity, and incapacitating nature of the emotional trauma that
still exists in the AI population today. And lastly, I think that mental health is a chronically
underfunded and neglected area of health care and this is an underlying factor in many of the AI
health issues. This is not a comprehensive list of factors that contribute to the disparities that
exist for AI/ANs but it may lend some insight into their history, their current situation and the
future of their healthcare.

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References
HealthyPeople.gov., (2012). Determinants of Health. [Webpage]. Retrieved from
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Koivusilta, L., Rimpela, A., & Vika, A. (2003). Health behaviors and health in adolescence as
predictors of educational level in adulthood: a follow-up study from Finland. Social
Science Medicine, 57(4), 577-593.
Mitchell, F.M., (2012). Reframing Diabetes in American Indian Communities: A Social
Determinants of Health Perspective. Health and Social Work, 71-79. doi:
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Office of Minority Health, (2012a,d,e). American Indian/Alaska Native Profile. [Webpage].
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http://www.minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=537&ID=6457
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http://www.minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3024
US Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services, (2001). Mental Health, Culture,
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